Case Report

A Patient with Colon Perforation due to Amebiasis: A Rare and Fatal Complication
Putu Niken, Herry Purbayu, Ummi Maimunah, Ulfa Kholili, Iswan A Nusi, Poernomo Boedi S, Titong Sugihartono, Budi Widodo, Nizam Oesman, Pangestu Adi, Hernomo O. Kusumobroto

Division of Gastroenterology and Hepatology Department of Internal Medicine Airlangga University School of Medicine -Dr Soetomo Teaching Hospital

Introduction

Amebiasis infection Entameba histolytica World problem 10% worlds population 100.000 deaths / year worldwide

Clinically amebic colitis is vaque, could wrongly dx as IBD delayed antiamebic, severe complication, death
Acute colitis with intestinal perforation is rare, less than 0.5 %, with mortality rate more than 40%
(Stanley, 2001; Haque, 2003; Rees, 2010)

Case
Chief complaint: abdominal pain 4 days . Nausea and vomiting, fever diarrhea 10 days before
Mrs W, 60 yo History Past Illness: diagnosed

as IBD treated Sulfasalazine 2X 500, Prednison 3X 1 tablet, DM (-)

Physical Examination and Laboratory Peritonitis

Manifestation
Physical examination missing bowel sound abdominal wall rigidity or guarding missing liver dullness Laboratory examination Leukocytosis, electrolyte abnormality X-ray free gas visible in abdominal cavity

Px

(Doherty, 2005;

Flasar, 2006)

Assesment:

peritonitis due to perforation of the intestine

exploratory laparotomy multiple perforation caecum, colon ascenden, transversum, & descenden Subtotal colectomy, ileostomy, and Hartmann procedure

Progress Report
.

HPA: amebiasis colon with ulceration and perforation.

Given Metronidazole 3x500mg iv
(12 days) improved &discharge

10 months later
COLONOSCOPY No complaints Stool: ery 5-10, leuco 510, amebic trophozoite + cyst + Serameba (+) titre > 1/32The asssment amebic

Tx: metronidazole 3x 500 mg

DISCUSSION
stool
cysts or motile trophozoites in stool specimen. detection in stool of E. histolytica specific antigen or DNA p a t i e n t

serum

Antiamebic antibodies detected with IHA sensitivity 70%

presence of amebae in classic flaskshaped lesions patology

(Haque, 2003; Soomro, 2009)

clinical consideration
clinical picture is vague could wrongly diagnosed IBD due to similar clinical findings

Suspected IBD should investigate for amebiasis serologically and stool examination avoid disastrous effects of steroids and immunosupressant in amebiasis
(Gupta, 2009; Rees, 2010)

Px wrongly assesed IBD due to diarrhea with bloody stool, abdominal cramps and fever in other health facility

treatment
Primary total resection treatment of choice.

Treatment of amebic colitis metronidazole 500 mg orally or iv 3x/ day for 710 days or 3550 mg/kg/day tid for 710 days. Short term txparasitic cure rate 80%. Long term tx 10 -12 months 100% parasitic cure.

Gupta, 2009; Rees, 2010

references
Gupta SS, Singh O, Shukla S, Mathur KR (2009) Acute Fulminant Necrotizing Amebic Colitis: a rare and fatal complication of amebiasis: a case report. Cases J 2: 655-668 Haque R, Huston CD, Huges M (2003) Currents concepts amebiasis. N Engl J Med 348: 1558- 1564 Rees SL (2010) Amebiasis and infection with free- living amebas In: Fauci A , Braunwald E, Kasper DL, Hauser SL, Longo DL, eds. Harrisons Gastroenterology and Hepatology. 17th edition. New York: McGraw-Hill 298303 Stanley SL (2001) Pathophysiology of amoebiasis. Trends in Parasitology 17: 280 -284 Soomro AA, Badwi JA (2009) Serodiagnosis of Amebiasis by Indirect Haemagglutination Test. Med Channel 15: 72-7
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